My View: When and why FHN invests in high-tech health care

Technological advances are one of the most important contributors in any health care organization’s ability to deliver care cost-effectively while, most importantly, improving patient outcomes.

By Michael Perry

Journal Standard

By Michael Perry

Posted May. 1, 2013 at 12:01 AM
Updated May 1, 2013 at 12:22 AM

By Michael Perry

Posted May 1, 2013 at 12:01 AM
Updated May 1, 2013 at 12:22 AM

Technological advances are one of the most important contributors in any health care organization’s ability to deliver care cost-effectively while, most importantly, improving patient outcomes.

However, providers should also be acutely aware of how technology can affect health care costs. Wise stewardship of resources, a key element in FHN’s mission, is one of our pivotal drivers when making decisions related to technology.

Health care professionals should be charged with continually keeping an eye on high-tech medical opportunities and evaluating costs compared with the current standards of results and patient safety. One of the fastest-growing examples is the da Vinci Surgical System, a $2.5 million robot-assisted device that uses slender arms to reach inside a patient to perform surgical procedures. The da Vinci system has enjoyed success with prostate surgery, where it is used commonly, and its use has started to expand into other types of procedures, such as hysterectomies.

The benefits and risks associated with using a robot-assisted device for hysterectomy was reported in February in an article in the Journal of the American Medical Association. The study of 264,758 women in 411 hospitals compared traditional laparoscopic surgery (hand-controlled, minimally invasive surgery) with robot-assisted surgery. The results found no clinical advantages of either; however, the robot-assisted surgery cost one-third higher, about $2,000 for an average hysterectomy.

The author questions whether commercialization and marketing of high-tech medical equipment like the da Vinci through the emergence of direct-to-consumer advertising is warranted in light of the higher cost with no better results. The study concludes: “When a new technology is equally or less effective and more expensive than a current technology, it [should not be the primary method chosen]. … Robotic surgery for conditions such as benign gynecologic disease would seem to fall into this category.”

Dr. James Breeden, president of the American Congress of Obstetricians and Gynecologists, urged health care providers in March 2013 “to separate the marketing hype from reality” when considering a surgical method for hysterectomy. “Just because it’s newer and higher technology doesn’t mean it’s better.”

In other publications, the national cost associated with robot-assisted surgery is estimated at $2.5 billion a year in the US. This seems like a big price to pay for results that have not improved upon traditional laparoscopic surgery that most hospitals perform.

Other issues when choosing laparoscopy, assisted surgery vs. robot: assisted surgery includes longer operative times for robot-assisted surgery (averages range from one to three hours more time under anesthesia, depending on procedure), the lack of important tactile feel when a surgeon uses a robot rather than his or her own hands, and the remote positioning of the surgeon from the patient, a serious concern in situations where an emergency arises that requires the surgery to be switched quickly to an open procedure.

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Also critical is the experience of the operating surgeon. Is the surgeon residency- and fellowship-trained or did he or she go to a one- or two-day course to learn? And how many procedures has he or she performed? Dr. Jim Hu of Brigham and Women’s Hospital in Boston, for example, has done more than 700 robot-assisted procedures, but it took him 150 to 200 to master the technique (The New York Times, February 2010).

Strong believers in evidence-based care, we at FHN feel that until a technology is proven to be cost-effective and safer and/or better for our patients, we will not invest in it. As technologies improve and costs are justifiable, we will invest in the systems and equipment that we believe best improve care for our patients and also respect their wallets.

Two direct and recent results of adhering to this philosophy are FHN’s consistent ranking in the lowest 20th percentile of cost to Medicare and the recent recognition we received from the world’s largest independent, nonprofit product- and service-testing organization as one of the top three hospitals in Illinois for patient safety.

As technology evolves, we will continue to study its application at FHN with the best interests of our patients always as our most important guide, and wise stewardship of our financial and human resources as another key determinant in deciding when and when not to make high-tech investments.

In the meantime, we’re proud of our providers, our staff and our achievements, and very proud indeed to offer northwest Illinois what we believe to be the best possible care that we can provide.